The goal of treating a patient with hyperthyroidism is to return the patient to the euthyroid state, to treat the signs and symptoms the patient possess, and to prevent complications. Nursing interventions that focus on an ongoing process that includes monitoring, protecting the patient from injury, reducing stress, teaching and follow-up care (Sommer, 2011 p. 513). Determine the patient’s ability and response to treatment including his/hers support system. Treatment measures include anti-thyroid medications, beta-adrenergic blockers, iodides, radioactive iodine therapy, and subtotal or total thyroidectomy.
Beta-adrenergic Blockers This medication is the treatment of choice for thyroiditis and is the first-line of treatment for hyperthyroidism depending on the condition. Doses can be tapered and discontinued once the patient has responded appropriately to anti-thyroid therapy and is no longer hyperthyroid (Blackwell, 2004, p. 423) Offer relief of the adrenergic symptoms of hyperthyroidism:
Tremor
Palpitations
Head intolerance
Nervousness
Tachycardia
Medications used:
Propranolol (Inderal)
Nadolol (Corgard)
Atenolol (Tenormin)
Iodides
Block the conversion of thyroxine (T4) to triiodothyronine (T3) and inhibit hormone release
Provide a rapid decrease in thyroid hormone levels
Used if beta blockers are unable to control the hyperthyroidism and before surgery for Graves’ disease to reduce gland vascularity
Anti-thyroid Drugs Act by interfering with the organificaiton of iodine by suppressing thyroid hormone levels and is used to long term treatment of Graves’ disease. Patients with moderate to severe hyperthyroidism should receive short term treatment with these drugs before radioiodine therapy and thyroid surgery (Gittoes & Franklyn, 1998, p. 548) Complications:
Relapse in patients who smoke, had large goiters, or had elevated thyroid-stimulating antibody levels at the end of therapy
Agranulocytosis
Polyarthritis
Rash, fever, GI symptoms
Arthralgia symptoms
Two common medications used: Methimazole (Tapazole): drug of choice for nonpregnant patients
Starting dose is 15 to 30mg per day
Can be given in conjunction with a beta blocker
Propylthiouracil (PTU): drug of choice for pregnant women
Blocks peripheral conversion of T4 to T3 in large doses
Starting dose is 100mg three times a day
Goal is to keep the free T4 level at the upper level of normal
Radioactive Iodine Radioactive iodine is a treatment for hyperthyroidism because it concentrates in the thyroid gland and destroys thyroid tissue.
When radioiodine is given, the thyroid cannot tell if the iodine is radioactive or not, thus the radioiodine accumulates in the cells that make thyroid hormone and remains there long enough to radiate the gland and slow thyroid production (Gittoes & Franklyn, 1998, p.549). It is the choice of treatment for most patients with Grave’s disease and toxic nodular goiter and is the treatment of choice Graves’ disease, multinodular goiter, toxic nodules in patients over 40 years, and relapses from anti-thyroid drugs (Reid & Wheeler, 2005, p. 627) Complications:
Delayed control of symptoms
Post treatment hypothyroidism of patients with Graves’ disease
Neck soreness, flushing, decreased taste
Surgery Surgery is rarely performed in patients with Graves’ disease unless radioiodine is refused, if there is a large goiter causing symptoms of compression in the neck, or failed medical treatment due to noncompliance or adverse effects of certain drugs (Gittoes & Franklyn, 1998, p. 550) Subtotal: most common
Preserves some of the thyroid tissue
Reduces the incidence of hypothyroidism to 25%, but recurrent hyperthyroidism occurs in 8% of patients (Reid & Wheeler, 2005, p. 629)
Total thyroidectomy:
For patients with severe disease or large goiters
Complications:
Damage to the recurrent laryngeal and external branch of the superior laryngeal nerves
Transient and permanent hypocalcaemia (Gittoes & Franklyn, 1998, p. 551)
Beta-adrenergic Blockers
This medication is the treatment of choice for thyroiditis and is the first-line of treatment for hyperthyroidism depending on the condition. Doses can be tapered and discontinued once the patient has responded appropriately to anti-thyroid therapy and is no longer hyperthyroid (Blackwell, 2004, p. 423)
Offer relief of the adrenergic symptoms of hyperthyroidism:
- Tremor
- Palpitations
- Head intolerance
- Nervousness
- Tachycardia
Medications used:Iodides
Anti-thyroid Drugs
Act by interfering with the organificaiton of iodine by suppressing thyroid hormone levels and is used to long term treatment of Graves’ disease. Patients with moderate to severe hyperthyroidism should receive short term treatment with these drugs before radioiodine therapy and thyroid surgery (Gittoes & Franklyn, 1998, p. 548)
Complications:
- Relapse in patients who smoke, had large goiters, or had elevated thyroid-stimulating antibody levels at the end of therapy
- Agranulocytosis
- Polyarthritis
- Rash, fever, GI symptoms
- Arthralgia symptoms
Two common medications used:Methimazole (Tapazole): drug of choice for nonpregnant patients
- Starting dose is 15 to 30mg per day
- Can be given in conjunction with a beta blocker
Propylthiouracil (PTU): drug of choice for pregnant womenRadioactive Iodine
Radioactive iodine is a treatment for hyperthyroidism because it concentrates in the thyroid gland and destroys thyroid tissue.
When radioiodine is given, the thyroid cannot tell if the iodine is radioactive or not, thus the radioiodine accumulates in the cells that make thyroid hormone and remains there long enough to radiate the gland and slow thyroid production (Gittoes & Franklyn, 1998, p.549). It is the choice of treatment for most patients with Grave’s disease and toxic nodular goiter and is the treatment of choice Graves’ disease, multinodular goiter, toxic nodules in patients over 40 years, and relapses from anti-thyroid drugs (Reid & Wheeler, 2005, p. 627)
Complications:
Surgery
Surgery is rarely performed in patients with Graves’ disease unless radioiodine is refused, if there is a large goiter causing symptoms of compression in the neck, or failed medical treatment due to noncompliance or adverse effects of certain drugs (Gittoes & Franklyn, 1998, p. 550)
Subtotal: most common
- Preserves some of the thyroid tissue
- Reduces the incidence of hypothyroidism to 25%, but recurrent hyperthyroidism occurs in 8% of patients (Reid & Wheeler, 2005, p. 629)
Total thyroidectomy:- For patients with severe disease or large goiters
Complications: